CT scan evaluation of the morphology of trochanteric & subtrochanteric fractures helps in the selection of appropriate implant for fixation of proximal femoral fractures, resulting in better surgical outcome.
Materials and methods:
CT scan evaluation done in 64 cases of intertrochanteric and subtrochanteric fractures since April 2012 to March2014. The fracture morphology of these fractures analyzed regarding stable or unstable fracture, integrity of posteromedial part of trochanter, severe comminution of lateral cortex of trochanter, quality of the bone based on their trabecular pattern, and fracture line extending into the subtrochanteric area. Dynamic hip screw, proximal femoral nailing, proximal femoral locking plate and cemented hemiarthroplasty were selected according to fracture morphology. Results compared with previous 60 surgically treated cases of trochanter & subtrochanteric fractures done based on the xray morphology of the fractures, for the period before April 2012.
Results: 2 cases of implant penetration into the joint, 11 cases of hip screw cut out, 9 cases of varus angulations, 4 cases of implant failure with nonunion occurred of the 60 cases done with only x ray evaluation, study done from September 2008 to March 2012. After 2 years of follow up only 4 cases of nonunion occurred after implant selection for surgical treatment of intertrochanteric and subtrochanteric fractures based on CT scan evaluation.
Conclusion: CT scan evaluation provides good method of choosing an implant in surgical management of trochanteric and subtrochanteric fractures.